Beckly Registration and Information Form
name of child	
date of birth...................................................
address............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................post code............................
phone.........................................................
mobile.........................................................
e-mail.................................................................................
name of parent 		
work place contact.......................................................................................................................
emergency contact 	 	
what is the key issue relating  your child................................................................................
..........................................................................................................................................................................................................................................................................................................
name of condition		drugs to be taken at Beckly		
time / dosage 			

details of other medication					details of special medical  needs				doctor's name	phone	name of consultant	phone	school attending	phone	social worker	phone	
speech  ability			understanding ability					
does your child use, signs, symbols makaton                                                          yes    / no     
does your child have a care plan /core assessment / management programme       yes / no

if yes to any please let us have copies

specific behaviour problems				
mobility /balance						toileting  / personal care									outdoor behaviour				
issues out of building				
travel problems				
allergies			
special foods/diet		feeding ability					
sports ability		swimming			any specific dislikes 							
special interests					social awareness / problems							

does your child use other support services (date/time)					
brothers / sisters  		ethnic monitoring (please circle your ethnic grouping) ….          White  / British   = Irish  =   other White   =  Asian =  Asian British =  Black    = Black British    =   Chinese   =  other ethnic group
Anything else you should tell us														
If there is further information you feel we should have please continue on a separate sheet or contact the office on 484433

Dear 

Activities and Sessions at Beckly   

Thank you for you enquiry about activities at Beckly. 
I am pleased to enclose a copy of our current general programme together with some general information about booking and registration requirements for attendance at Beckly.

Please feel free to contact the Centre Manager to discuss your child’s needs and what might be potential sessions for your child to attend. We try to accommodate a broad range of children and young people within the sessions but it is useful to check appropriateness and suitability for your child.

Wherever possible we like to arrange for the child/ young person to visit (for as many times as necessary) to check that they will enjoy and benefit from attending Beckly.

If you would like to discuss this further or to arrange a visit or booking please contact the Beckly Office.  An answer phone is always connected so please leave a message.

Yours faithfully

Sarah Noble
Centre Manager